Provider Demographics
NPI:1841564515
Name:KARLESKY, AUDREY JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:JEAN
Last Name:KARLESKY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 EDEN RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4275
Mailing Address - Country:US
Mailing Address - Phone:717-735-0515
Mailing Address - Fax:866-568-5755
Practice Address - Street 1:780 EDEN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4275
Practice Address - Country:US
Practice Address - Phone:717-735-0515
Practice Address - Fax:866-568-5755
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020755310001Medicaid